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Hirayama Disease A kind of cervical myelopathy related to flexion movements of the neck. Hirayama et al, first reported this disease in 1959. Mainly in young males between the ages of 15 and 25 years. In flexion : anterior shifting of posterior dura at the lower cervical spinal canal (primary pathologic mechanism). In non-flexion : asymmetric cord atrophy at the lower cervical cord. Suggested pathogenic mechanism. imbalanced growth between the patient’s vertebral column and spinal canal contents. tight dural canal - cannot compensate during flexion - anterior shifting of the posterior dural wall, with consequent compression of the cord. ‘mass’ : congestion of the posterior internal vertebral venous plexus rather than vascular malformations or tumors (epidural plexus)